Welcome! Please review all plan information and rates when making a selection. Check out our Benefit Cost Calculator for assistance Benefit Cost Calculator
Highlighted below are the required forms to enroll. Full-time (8hr) employees are required to enroll in a medical plan. If an employee has other coverage, they can enroll in a full-time waived option plan. The waived option plan enrollment form is required with verification of other coverage. Benefits are effective the first of the month following the date of hire.
All documents are DUE: 30-days from your date of hire
1. Medical Election Form
MEDICAL PLAN ELECTION FORM
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2. Medical Plan Enrollment Form
(Kaiser, Anthem Blue Cross, full-time Waived Option Plan and part-time Waiver for <7.2 hrs)
See below for plan descriptions
ANTHEM BLUE CROSS ENROLLMENT FORM
KAISER ENROLLMENT FORM
FULL-TIME WAIVED OPTION FORM
WAIVER FORM
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3. Dental Enrollment Form (if enrolling)
See below for plan descriptions
Delta Dental - ENROLLMENT FORM
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4. Vision Enrollment Form (if enrolling)
See below for plan descriptions
MES ENROLLMENT FORM
VSP ENROLLMENT FORM
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5. Minnesota Life Enrollment and Beneficiary Form (District-paid)
BENEFICIARY FORM
Minnesota Life Plan Summary and Rates
Minnesota Life Enrollment Form
Minnesota Life Evidence of Insurability Form
(Evidence of Insurability is required if electing above the guaranteed issued amount)
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6. Disability Acknowledgement Form
Disability Acknowledgement Form
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IMPORTANT: If enrolling dependents, you must provide proof of dependent relationship. Please see dependent verification requirements: Dependent Verification Documents
Spouse: First page of the previous year Federal tax return showing the married filing status.
Child(ren): Birth Certificate naming employee or spouse as a parent.
Additional Information
INSURANCE BOOKLET - MANAGEMENT ACTIVE
21-22 PLAN RATES
Medical Plan Descriptions
KAISER $10
KAISER $20
ANTHEM PREMIER HMO
Premier HMO Prescription Coverage
ANTHEM CLASSIC HMO
Classic HMO Prescription Coverage
ANTHEM CLASSIC PPO $20
Premier PPO Prescription Coverage
ANTHEM CLASSIC H.S.A.
Anthem Blue Cross Anthem Blue Cross
HMO Provider Finder PPO Provider Finder
American Specialty Health (ASH) Chiropractic
All Medical Plan Members: 800-678-9133
Prescription Drug Program for non-Kaiser Members
NAVITUS CUSTOMER CARE
HOURS: 24 Hours a Day | 7 Days a Week
866-333-2757 (toll-free) TTY (toll-free) 711
MAILING ADDRESS: Navitus Health Solutions P.O. Box 999 | Appleton, WI 54912-0999
Anthem Blue Cross members have access to a MDLIve appointment for a $5 co-pay.
Please check the link here for more information: MDLive Appointment Information
Additional Medical Plan Forms and Information
IMPORTANT: If enrolling dependents, you must provide proof of dependent relationship. Please see dependent verification requirements: Dependent Verification Documents
Anthem Temp Medical ID Card
COSTCO Prescription Drug Flyer - Not valid for Kaiser members
Dental Plan Descriptions
DELTA CARE HMO PLAN
Please visit the Delta Dental website for provider directory, benefits, and claim forms:
Vision Plan Descriptions
Plan Summary - Medical Eye Services (MES)
Plan Summary - Vision Service Plan (VSP)